Permanent Identifier

Abstract

: Objective? To analyse survival and retention rates of the Tanzanian care and treatment programme. Methods? Routine patient-level data were available from 101 of 909 clinics. Kaplan-Meier probabilities of mortality and attrition after ART initiation were calculated. Mortality risks were corrected for biases from loss to follow-up using Egger's nomogram. Smoothed hazard rates showed mortality and attrition peaks. Cox regression identified factors associated with death and attrition. Median CD4 counts were calculated at 6?month intervals. Results? In 88,875 adults, 18% were lost to follow up 12?months after treatment initiation, and 36% after 36?months. Cumulative mortality reached 10% by 12?months (15% after correcting for loss to follow-up) and 14% by 36?months. Mortality and attrition rates both peaked within the first six months, and were higher among males, those under 45?kg and those with CD4 counts below 50?cells/?l at ART initiation. In the first year on ART, median CD4 count increased by 126?cells/?l, with similar changes in both sexes. Conclusion? Earlier diagnoses through expanded HIV testing may reduce high mortality and attrition rates if combined with better patient tracing systems. Further research is needed to explore reasons for attrition.